We have currently rolled out the EPM and EMR to one site and are in the process of implementing their lab interface as well as upgrading them to the newest KBM version of NextGen.
One other site has had a successful bi-directional lab interface implementation (they were already using the EHR) with Quest and they are happily using this and glad to rid themselves of the "paper mess".
We began chart abstraction at our most remote site and all training has been done via WebEx. We hope to get as much of the diabetic patients and "frequent flyers" abstracted prior to our on-site EHR training for them. This allows them to begin getting familiar with the EHR on a limited basis and provides us the time to focus on our other site implementation.
Our main focus currently is on getting the EMR rolled out to our third site. The biggest problem we've encountered is getting the training time necessary. This is an ongoing problem especially with the economy being what it is. Closing down the clinic to allow for adequate training is costly and many times when we're on site we simply work with the staff as time (and patient loads) allow. We do have one provider (our champion) who has been using the EHR system on a limited basis at this location. The medical director has agreed to allow us to attempt a scaled down "go live" on Fridays only. We would have two providers (our medical director rotates there Fridays) that have used the EHR and (along with myself) would provide the necessary help to other staff members on this day. Scheduling would be lighter to allow for the learning curve initially. If this goes well after a few weeks we will gradually add in other days as the staff becomes more comfortable with the EHR and new workflow.
Sustainability and ongoing training are always areas of concern. We generally use consultants and our own internal staff to manage ongoing training and IT/EHR based maintenance, administration, upgrades etc. We find that our staff as well as the consultants we use have a much better understanding of how "tribal" health programs operate then NextGen and can offer the training at a greatly reduced cost. We do not tend to have a great deal of interaction with the vendor other then with our initial implementation process and possibly some classes in terms of ongoing trainings. That is not to say that we don't lean on them heavily for support calls. In the case of NextGen I do find that their support is generally very helpful and we do utilize it often.
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5 comments:
Michael - I think the "EHR Fridays" are a very innovative response to an increasing challenge of maintianing productivity while trying to implement a disruptive technology and managem change. Please let us know how it goes, especially as the records become split between paper and electronic. A question I have (and I might post this to the larger group) is: at what point is the legal record the electronic record versus the paper chart?
Thanks for updating us on your progress!
Thanks SA. The key here is that we have a provider that rotates to this location on Fridays but still maintains his patient base, meaning this really wouldn't work as well if we had to split between paper and electronic for a patient. The idea is that on a very limited basis some of the staff can get used to using the EHR only for those patients that the provider has already been seeing at his other location (only about 15 minutes away). I should have clarified that in my post. I have thought long about the possibility of splitting between paper and electronic and really haven't come up with a method that is "fail safe" although we're definitely trying to work that out. The legal ramifications are also of concern of course and I would definitely defer this to our compliance dept. as they are better suited to answer this type of question.
I thought it best I add a bit more to my previous comment. We are looking to be able to print a master document out after an electronic visit and add that to the paper chart to handle the "split". The problem lies in the reverse of that scenario. After an electronic visit if the patient had to be seen by a "paper" based provider then you would have a gap in the electronic chart. This is the part we are struggling with.
It is one thing to have a patient that goes "electronic" who may still need some historical data abstracted from his/her paper chart but to go back and forth between paper and electronic visits is not an acceptable solution at this point.
Michael - thanks for the clarification. I was thinking that a paper based note could be scanned into the electronic chart in the same way that an outside consult would be, however, that doesn't capture the prescriptions or changes in medications, problems, or any other structured text. Its a tough problem.
SA - Yes, and actually the scanned paper visit presents two problems:
1. the providers don't like to go back and forth between the electronic chart and the scanned visit as it makes the flow difficult and
2. This creates problems for our reporting system as the data is not captured. As we move more toward patient based as well as aggregate reporting for our staff we need to make sure the data is complete.
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